Since 2000, the International Rescue Committee has documented the humanitarian impact of war and conflict in DR Congo through a series of five mortality surveys.

The first four studies, conducted between 2000 and 2004, estimated that 3.9 million people had died since 1998. Less than 10 percent of all deaths were due to violence, with most attributed to easily preventable and treatable conditions such as malaria, diarrhoea, pneumonia and malnutrition.

The fifth and most recent survey, covering the period from January 2006 to April 2007, aimed to update the humanitarian situation in DR Congo by providing an update on mortality. Investigators surveyed 14,000 households across all 11 provinces, resulting in wider geographic coverage than any of the previous IRC surveys.

The survey found that elevated mortality rates persist across DR Congo with a national crude mortality rate (CMR) of 2.2 deaths per 1,000 people - 57 percent higher than the average rate for sub-Saharan Africa. Based on the results of the five IRC studies, we now estimate that 5.4 million excess deaths have occurred between August 1998 and April 2007. An estimated 2.1 million of those deaths have occurred since the formal end of war in 2002.

As with previous IRC studies in DR Congo, the survey found that the majority of deaths have been due to infectious diseases, malnutrition and neonatal- and pregnancy-related conditions. Increased rates of disease are likely related to the social and economic disturbances caused by conflict, including disruption of health services, poor food security, deterioration of infrastructure and population displacement.

Children, who are particularly susceptible to these easily preventable and treatable conditions, accounted for 47 percent of deaths, even though they constituted only 19 percent of the total population.

The only region to record an improvement in the CMR since 2004 was the five provinces in the eastern region where declines in violent deaths coincided with a more determined international peacekeeping effort. Renewed violence in the Kivus now threatens these measurable gains.

Sustained, measurable improvements in mortality and health will require years of unwavering commitment from the Congolese government and tenacious engagement from the international community on a range of humanitarian, military and political issues. It will also require a determination to intervene rapidly and effectively when new emergencies arise.

Without such an approach, improvements in mortality and other key public health indicators will be impossible to achieve and sustain.

March 2007